Search Results (1,289)

This systematic review assessed transcriptomic evidence on the molecular mechanisms underlying spontaneous preterm birth (sPTB). Major electronic databases were searched from inception to October 2025. Eligible studies examined RNA transcriptomic profiles from maternal pregnancy-related tissues or biofluids in spontaneous preterm labor (sPTL) or preterm prelabor rupture of membranes (PPROM), while indicated or iatrogenic preterm births were excluded. Two reviewers independently screened studies, extracted differentially expressed genes (DEGs), and assessed study quality. DEGs were summarized by tissue type, and recurrent concordant genes were analyzed using Gene Ontology, Reactome, and Kyoto Encyclopedia of Genes and Genomes enrichment analyses, with false discovery rate < 0.05 considered significant. Twenty studies were included. Transcriptomic data were derived from placental villi, maternal peripheral blood, decidua, fetal membranes, myometrium, amniotic fluid, and vaginal secretions. Placental villi findings suggested proliferative-metabolic reprogramming and impaired maternal–fetal immune–structural homeostasis, whereas maternal blood profiles reflected systemic immune–inflammatory activation and dysregulated lipid-metabolic pathways. sPTL and PPROM showed potentially distinct signatures involving extracellular matrix disruption, collagen remodeling, matrix degradation, and myeloid/neutrophil-associated inflammation. Transcriptomic profiling may support non-invasive sPTB risk assessment, but standardized, phenotype-specific longitudinal studies are needed to confirm predictive value and clinical utility. Full article

Hepcidin is a multifunctional peptide involved in innate immunity and iron homeostasis, yet its earliest developmental regulation in sturgeons remains poorly understood. Here, we investigated maternal loading and embryonic expression patterns of hepcidin transcripts (hamp) in Siberian sturgeon (Acipenser baerii). RT-qPCR detected hamp transcripts in all 17 unfertilized egg (UFE) batches examined; however, maternally loaded transcript abundance varied markedly among batches, with up to a 14.8-fold difference, indicating substantial heterogeneity in the molecular starting state of embryos. In contrast, female traits, including age, body weight, and condition factor, as well as fertilization rate and hatching success, were not significantly correlated with UFE hamp transcript abundance (Spearman’s rank correlation with BH-FDR adjustment; q > 0.05). Developmental expression analysis from UFE to first hatch was then performed using five developmental series (DevSeries 1–5) that represented relatively high, intermediate, and low UFE baseline levels within the statistically differentiated UFE dataset (Welch ANOVA/Games–Howell post hoc, p < 0.05). The developmental dataset showed significant DevSeries, stage, and DevSeries × stage effects, indicating that embryonic hamp expression profiles differed among DevSeries (two-way ANOVA, p < 0.05). High-loading DevSeries (DevSeries 2 and 4) showed prolonged early persistence followed by later re-elevation, whereas low-loading DevSeries (DevSeries 3 and 5) maintained lower overall abundance but displayed more evident stage-linked increases during embryogenesis. Collectively, these findings show that maternally loaded hamp transcripts are associated with embryonic expression profiles and support the view that maternal transcript abundance provides an initial baseline that should be considered when interpreting early developmental expression profiles of immune- and iron-regulation-related genes in this chondrostean species. Full article

Seasonal influenza remains an important public health concern worldwide, and pregnant women represent a particularly vulnerable population due to physiological and immunological changes associated with gestation. Influenza infection during pregnancy has been associated with adverse maternal, fetal and neonatal outcomes. This narrative review summarizes current evidence regarding maternal influenza infection and influenza vaccination during pregnancy. A structured literature search was conducted using PubMed, Embase and Cochrane Library databases. Studies published between 2020 and 2025 addressing maternal influenza infection, pregnancy outcomes and influenza vaccination were reviewed. Current evidence suggests that maternal influenza infection is associated with increased risks of spontaneous abortion, preterm birth, hospitalization and congenital malformations, especially neural tube defects and congenital heart defects when infection occurs during the first trimester. In contrast, evidence regarding long-term neurodevelopmental outcomes remains inconsistent. Influenza vaccination during pregnancy demonstrates moderate-to-high effectiveness in preventing maternal and neonatal influenza infection and shows a favorable safety profile. Available evidence also suggests that neuraminidase inhibitors, particularly oseltamivir, can be used safely during pregnancy without increasing the risk of congenital malformations or adverse neonatal outcomes. Influenza vaccination during pregnancy should continue to be promoted as a safe and effective public health strategy to protect both mothers and infants. Full article

Background/Objectives: Children with chronic neurological and neurodevelopmental disorders (CNDD) constitute a medically vulnerable population in whom routine childhood immunization may be interrupted because of clinical complexity and parental concerns. This study aimed to evaluate immunization patterns, timing of vaccination interruption, and associated clinical and sociodemographic factors in children with CNDDs followed at a tertiary pediatric neurology center. Methods: This prospective cross-sectional study included 545 children aged 1–18 years with chronic neurological and neurodevelopmental disorders evaluated between September and November 2025. Immunization status according to the Turkish National Immunization Program was classified as fully vaccinated, partially vaccinated, or not vaccinated. Information regarding non-NIP vaccines, timing of vaccination interruption, parental characteristics, and motor impairment severity assessed using the Gross Motor Function Classification System (GMFCS) was collected. Associations between vaccination status and clinical variables were evaluated using chi-square tests and logistic regression analysis. Results: Overall, 72.1% of children were fully vaccinated, 25.0% were partially vaccinated, and 2.9% had never received routine childhood vaccines. Immunization status differed significantly across diagnostic groups (p < 0.001). Partial vaccination was more common than complete vaccine refusal across most diagnostic categories. Lower full vaccination rates were observed in autism spectrum disorder and cerebral palsy, whereas higher coverage was observed in Down syndrome. Among partially vaccinated children, interruption of routine immunization after 48 months was the most frequent pattern. In multivariable analysis, only maternal age remained significantly associated with incomplete or no vaccination. Conclusions: Incomplete immunization in children with CNDDs was more commonly characterized by partial vaccination than complete vaccine refusal and followed diagnosis-specific patterns. Evaluating vaccination continuity during pediatric neurology follow-up may help support diagnosis-sensitive immunization counseling. Full article

Adverse pregnancy outcomes (APOs), including preterm birth, preeclampsia, low birth weight, recurrent miscarriage, gestational diabetes mellitus, and fetal growth restriction, remain major threats to maternal and offspring health. Increasing evidence links the maternal microbiome to pregnancy health, but most studies have examined individual microbial niches rather than their interactions. The oral cavity and gut are anatomically and immunologically connected and form a bidirectional oral–gut microbiota axis through microbial trafficking, immune signaling, and metabolite-mediated feedback. Emerging studies suggested that oral dysbiosis, periodontal inflammation, and gut microbial remodeling were associated with APOs, although direct causal evidence in human pregnancy remains limited. This review summarizes pregnancy-related remodeling of the oral–gut microbiota axis, evaluates clinical and experimental evidence linking oral and gut dysbiosis to APOs, and discusses potential mechanisms, including microbial translocation, immune and inflammatory activation, metabolic remodeling, epigenetic regulation, and outer membrane vesicle-mediated signaling. Candidate biomarkers, probiotic and dietary intervention strategies, and current translational limitations are also discussed. Overall, the oral–gut microbiota axis offers a useful framework for understanding microbiome-associated APOs, but standardized sampling, longitudinal cohorts, and mechanistic validation are required before clinical application. Full article

Porcine epidemic diarrhea virus (PEDV) remains one of the most critical enteric coronaviruses affecting the global swine industry. PEDV causes severe diarrhea, dehydration, and high mortality in neonatal piglets. Despite the widespread use of commercial vaccines, persistent PEDV outbreaks worldwide indicate that current vaccination strategies provide suboptimal protection. Increasing evidence suggests that the limited effectiveness of current control strategies is primarily attributable to two interrelated factors: continuous antigenic variation among circulating PEDV strains and inadequate induction of maternal mucosal immunity. Unlike systemic viral infections, effective protection against PEDV in neonatal piglets predominantly depends on lactational immunity mediated by the gut–mammary gland–secretory IgA (sIgA) axis. However, most currently available vaccines predominantly induce systemic IgG responses and fail to effectively stimulate intestinal immune imprinting or sustain sIgA secretion in colostrum and milk. In this review, we summarize the mechanisms underlying PEDV evolution and maternal mucosal immunity, with particular emphasis on the gut–mammary gland–sIgA axis. We further discuss the recent advances in and limitations of current vaccine platforms and propose an integrated framework for broadly protective PEDV vaccines based on structural antigen optimization, mucosal-targeted immunization, and sIgA-oriented evaluation systems. This framework may provide new insights into the rational design of more effective maternal vaccines against PEDV and other enteric coronaviruses affecting pigs. Full article

Objective: This study evaluated hepatitis B vaccine (HepB) uptake, associated influencing factors, and post-vaccination immune responses among preterm infants residing in Fujian Province. The findings can support targeted improvements in hepatitis B prevention and control strategies tailored for this high-risk neonatal population. Methods: We conducted a multicenter cross-sectional study combined with short-term prospective serological follow-up across five counties, cities and districts of Fujian Province between 2022 and 2023. A total of 779 eligible preterm infants were enrolled in this study. We collected demographic information of participating mothers and infants, as well as complete HepB vaccination records throughout the study period. For 363 enrolled infants, we performed serological tests to detect hepatitis B surface antigen (HBsAg) and hepatitis B surface antibody (HBsAb) at 1–2 months after they completed the full HepB vaccination series. To explore factors linked to timely administration of the first HepB dose (HepB1), completion of the full vaccination course and HBsAb serostatus, we adopted a set of statistical approaches including descriptive statistics, the chi-square test (Fisher’s exact test was used for groups with small sample sizes) and binary logistic regression. Results: The timely HepB1 vaccination rate among all preterm infants was 78.18%, while 63.80% completed the full vaccination schedule as required. In the serology cohort, the HBsAb positive rate was 90.91%, and 8.82% of infants showed double-negative HBsAg and HBsAb results, indicating susceptibility to HBV infection. Multivariate analysis identified multiple risk factors for delayed vaccination. Preterm infants were more likely to receive vaccinations late if their mothers tested HBsAg-negative (HepB1: OR = 25.231, 95%CI: 4.997–127.406; full-course HepB: OR = 2.440, 95%CI: 1.395–4.269), were delivered in county-level or lower-tier medical facilities (HepB1: OR = 3.724, 95%CI: 2.107–6.580), or were born via cesarean section (HepB1: OR = 3.460, 95%CI: 2.169–5.520; full-course HepB: OR = 1.954, 95%CI: 1.411–2.704). Additional risk factors included a gestational age below 34 weeks (HepB1: OR = 4.369, 95%CI: 1.894–10.081; full-course HepB: OR = 2.237, 95%CI: 1.148–4.359) and a birth weight less than 2500 g (HepB1: OR = 2.251, 95%CI: 1.397–3.629; full-course HepB: OR = 1.513, 95%CI: 1.065–2.150). Conclusions: Preterm infants enrolled from five regions in Fujian Province achieved robust immune protection following standard HepB vaccination. However, timely first-dose coverage and on-schedule full-course vaccination remain suboptimal in this cohort. Observed gaps in routine vaccination management at primary care settings highlight a key area for improvement in local hepatitis B prevention. Targeted standardized training for maternity care staff at county-level facilities, paired with a full-cycle follow-up system for preterm infant vaccination, may further strengthen hepatitis B mother-to-child transmission (MTCT) interruption in the study regions. Full article

Background: The endometrial immune environment regulates maternal immune tolerance and plays a key role in embryo implantation. We investigated whether its impact on reproductive outcomes differs between fresh and frozen embryo transfer (FET) cycles. Methods: In this prespecified secondary analysis of a prospective randomized study, 493 good-prognosis IVF patients underwent endometrial immune profiling before embryo transfer. Patients with a balanced profile received standard care, whereas those with immune dysregulation were randomized to conventional or immune-guided precision care. Live birth rates (LBRs) were analyzed according to immune status, transfer type, and treatment strategy. Results: A transfer type-specific effect was observed. In FET cycles, a balanced immune profile was associated with higher LBR compared with immune dysregulation (52.4% vs. 14.7%; adjusted OR 5.32 [95% CI 1.53–20.92]; ARD +37.7%). Precision care improved LBR compared with conventional management (48.6% vs. 14.7%; OR 5.03 [1.66–17.63]; ARD +33.9%). No significant association between immune status and reproductive outcomes was observed in fresh transfers. Conclusions: The impact of the uterine immune environment differed according to embryo transfer type and was predominantly observed in FET cycles. These findings suggest that endometrial immune competence may be particularly relevant to implantation success after frozen embryo transfer and warrants confirmation in larger prospective studies. Full article

Background: Low-birth-weight (LBW, <2500 g) infants are at increased risk of suboptimal hepatitis B vaccine responses; yet, data on their immunogenicity patterns and modifiable determinants remain limited. This study aimed to assess hepatitis B vaccine immunogenicity in LBW infants and to examine whether postnatal catch-up growth and maternal–neonatal characteristics are independently associated with antibody levels. Methods: We enrolled 511 LBW infants who completed the recommended 3-dose hepatitis B vaccination series at 0, 1, and 6 months. Blood samples were collected 4–6 weeks after completion of the full vaccination series. Geometric mean concentration (GMC) and seroprotection rate (SPR, anti-HBs ≥ 10 mIU/mL) were evaluated. Catch-up growth was quantified as the change in weight-for-age Z-score between 6 and 8 months of age (ΔWAZ). Multivariable linear regression was used to identify independent predictors of log-transformed antibody titers, adjusting for gestational age, maternal hepatitis B surface antigen (HBsAg) positivity, maternal body mass index (BMI), maternal fasting glucose, maternal thyroid disease, infant hemoglobin at 6 months, and ΔWAZ. Results: The overall SPR was 99.41% (508/511), with a GMC of 1045.37 mIU/mL (95% CI: 916.24–1192.70). SPR remained consistently high across all subgroups. In multivariable analysis, ΔWAZ was not significantly associated with antibody levels (β = −0.063, p = 0.571). Maternal HBsAg positivity showed no significant association (β = −0.104, p = 0.792). Maternal thyroid disease was independently associated with higher antibody levels (β = 0.793, 95% CI: 0.213–1.373, p = 0.007). None of the other covariates reached statistical significance. Conclusions: Hepatitis B vaccination demonstrated high immunogenicity in LBW infants, with very high seroprotection rates. Postnatal catch-up growth did not independently influence antibody levels. The significant positive association between maternal thyroid disease and infant antibody response warrants further prospective investigation. Full article

Gestational diabetes mellitus (GDM) is an increasingly prevalent metabolic disorder of pregnancy, driven by rising maternal age, obesity, and complex metabolic–inflammatory interactions. Emerging evidence implicates the maternal microbiome as a key modulator of metabolic adaptation during gestation; however, its precise role in GDM pathogenesis remains incompletely defined. This narrative review synthesizes current knowledge on microbiome alterations across gut, vaginal, and oral niches, focusing on their contribution to insulin resistance, metabolic endotoxemia, and immune dysregulation. GDM is consistently associated with reduced microbial diversity, depletion of beneficial taxa (e.g., Akkermansia, Bifidobacterium, Faecalibacterium), and expansion of pro-inflammatory pathobionts, which collectively may impair intestinal barrier integrity and promote low-grade systemic inflammation. These mechanisms are linked to altered insulin signaling and adverse maternal–fetal outcomes. In parallel, microbiome-derived metabolites and early taxonomic signatures have been proposed as potential biomarkers for first-trimester risk stratification, offering an opportunity to overcome the limitations of late diagnostic approaches such as the oral glucose tolerance test. Despite these advances, most available evidence remains associative, with substantial heterogeneity across studies and limited mechanistic validation. The clinical utility of microbiome-based interventions—including dietary modulation, prebiotics, and probiotics—remains promising but inconclusive, with outcomes highly dependent on individual, microbial, and methodological factors. Overall, the maternal microbiome represents a compelling but still evolving target in GDM research. Future progress will depend on standardized methodologies, longitudinal multi-omics studies, and the development of precision medicine approaches capable of integrating microbial, metabolic, and host data. Such advances may enable earlier diagnosis, targeted prevention, and ultimately the disruption of intergenerational metabolic risk. Full article

Neonatal defense against pathogens relies on maternal antibodies transferred both through the placenta (IgG) and through breast milk (primarily secretory IgA). Maternal IgG antibodies are transferred across the placenta to the fetus mainly via the neonatal Fc receptor (FcRn), which is expressed at high levels in placental syncytiotrophoblasts, and results in the acquisition of maternal-fetal IgG. Transplacental transfer via the FcRn pathway can provide therapeutic proteins and protective antibodies following maternal vaccination. However, maternal IgG antibodies can bind to vaccine antigens such as measles, tetanus, and poliovirus, resulting in rapid clearance through FcgRIIB-mediated inhibition and inadequate B cell activation. In this way, they can inhibit de novo immune responses and significantly reduce vaccine response. On the other hand, the interference that breast milk-derived antibodies may have on vaccine-induced immunity is still largely unknown. Vaccination against influenza, pertussis, and COVID-19 during pregnancy or lactation has been shown to induce the production of protective, pathogen-specific, secretory IgA and IgG antibodies in breast milk. Conversely, studies found that breast milk-derived antibodies of vaccinated mothers reduced vaccine-induced immunity in breastfed infants by accelerating the clearance of vaccine antigen, resulting in reduced antigen availability and reduced plasma cell formation after vaccination. Additional factors in middle- and low-income countries, including environmental (increased microbiome diversity, environmental intestinal dysfunction, malnutrition, co-infections) and breastfeeding practices, may exacerbate the interference effect of maternal antibodies. Current evidence supports that breastfeeding is associated with a reduced immunological response exclusively to the rotavirus vaccine. However, the limited evidence base to date precludes definitive conclusions regarding the role of breast milk-derived antibodies in modulating vaccine-induced immunity. Nevertheless, the evidence suggests that although maternal antibodies may theoretically reduce vaccine immunogenicity, the overall protective benefits of breastfeeding outweigh any potential interference with vaccine responses. Full article

Every year, respiratory syncytial virus (RSV) causes an estimated 33 million lower respiratory tract infections in children under five years of age, driving millions of hospitalizations worldwide and substantial mortality in developing countries. For 28 years, the monoclonal antibody (mAb) palivizumab has been the principal agent for RSV immunoprophylaxis, reducing hospitalization in defined high-risk groups through monthly intramuscular dosing. The recent approval of two second-generation long-acting mAbs, nirsevimab and clesrovimab, and maternal preF vaccine has fundamentally changed the RSV prevention landscape. In contrast to palivizumab, the long-acting mAbs offer single-dose seasonal protection across a broader infant population, enabling universal immunization programmes for the first time. In this review, we conjointly examine nirsevimab and clesrovimab across their mechanisms of action, pharmacokinetics, efficacy, safety and cost-effectiveness, using palivizumab as the reference standard. Cross-trial efficacy comparisons are complicated by differences in study populations and endpoint definitions; however, when these factors are considered, the available evidence suggests that all three agents offer broadly comparable protection against severe RSV disease. All three agents also demonstrate favourable and comparable tolerability profiles. Nirsevimab is now supported by a substantial body of real-world evidence confirming effectiveness in routine immunization programmes that closely align with registrational studies. Clesrovimab, as the newest agent, currently lacks real-world effectiveness, and both long-acting monoclonals require further confirmatory evidence in high-risk groups. Overall, existing data support that both monoclonals have equivalent efficacy and safety profiles as palivizumab, and choice should be based on cost-effectiveness and local availability, with consideration given to optimal integration of infant immunoprophylaxis alongside maternal RSV vaccination programmes. Full article

Background: Type 2 inflammatory diseases are among the most common chronic inflammatory conditions in childhood and represent a growing global health burden. Increasing evidence suggests that early-life nutritional exposures may influence immune programming and allergic disease development. This Position Paper aims to summarize the current evidence regarding the immunomodulatory role of polyunsaturated fatty acids (PUFAs), particularly omega-3 long-chain fatty acids, in the prevention of allergic diseases during early life. Methods: A scoping literature review and consensus process were conducted to map biological mechanisms and clinical evidence linking omega-3 PUFAs with allergic disease prevention. This document analyzed experimental, observational, and randomized controlled studies evaluating maternal prenatal/lactational omega-3 exposure. The clinical evidence was qualitatively appraised using study-design-specific Joanna Briggs Institute (JBI) Critical Appraisal Tools. Particular attention was given to immune modulation, inflammatory pathways, epithelial barrier function, gut microbiota interactions, and the ferroptosis–immune–metabolic axis. Results: Omega-3 PUFAs, including eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), exert immunomodulatory and anti-inflammatory effects through multiple mechanisms, including specialized pro-resolving mediator production, regulation of T-helper cell responses, cytokine modulation, maintenance of epithelial barrier integrity, and microbiota interaction. Emerging evidence also supports their involvement in oxidative stress and ferroptosis regulation. Current clinical evidence, particularly from higher-quality prenatal randomized trials and evidence syntheses, suggests that adequate maternal omega-3 intake during pregnancy and lactation may reduce the risk of respiratory allergic outcomes, especially wheezing and asthma, in selected offspring. Conclusions: Adequate omega-3 PUFA intake, such as 2 g/die, during critical windows of immune maturation may represent a valuable strategy for the primary prevention of allergic diseases. Current evidence most strongly supports supplementation during pregnancy and lactation, particularly in populations with low dietary omega-3 intake or increased allergic risk. Omega-3 supplementation should be considered within a broader multifactorial preventive approach aimed at promoting immune tolerance and reducing the future burden of allergic diseases. Full article

Oocyte formation occurs successfully within a meticulously controlled follicular environment characterized by well-documented endocrine, metabolic, and paracrine signals. Yet, the immunological landscape of the follicle and its role in influencing oocyte competency has received less attention in research. Growing research indicates that the ovarian follicle functions as an immunological-active niche necessitating a precise equilibrium between controlled inflammation and targeted immune tolerance. The programmed cell death-1 (PD-1) receptor and its ligand PD-L1 constitute a crucial immune checkpoint pathway, essential for sustaining peripheral immunological tolerance and averting excessive immune activation. Despite their comprehensive research in cancer biology and maternal–fetal interactions, their possible function in the follicular microenvironment remains mostly unexamined. We propose that PD-1/PD-L1 signaling may facilitate the formation of a localized immune-tolerant milieu inside the follicle to safeguard the developing oocyte from inflammatory injury and immune-mediated stress. The disturbance of this suggested equilibrium may lead to a pro-inflammatory follicular environment, compromised granulosa cell function, and modified oocyte maturation, hence affecting fertilization and embryonic developmental potential. In clinical contexts with immunological dysregulation, such as endometriosis, polycystic ovarian syndrome, and unexplained IVF failure, such processes may be especially significant. The purpose of this narrative review is to assimilate the current comprehension of immune regulation in the follicle with the established biology of PD-1/PD-L1 and to investigate a potential correlation between immune checkpoint signaling, oocyte competence, and assisted reproductive outcomes. Considering the follicle as an immune-regulated microenvironment offers a new paradigm for comprehending infertility and identifying novel indicators or therapeutic targets. Full article

Cardiovascular disease (CVD) is the leading cause of morbidity and mortality worldwide, accounting for a substantial proportion of global deaths. Increasing evidence indicates that cardiovascular susceptibility is shaped during fetal development, where the intrauterine environment plays a critical role. Maternal–fetal crosstalk, mediated largely through placental function, coordinates the transfer of metabolic, endocrine, and immune signals that are essential for normal cardiac and vascular development. Disruptions in maternal physiology—including metabolic disorders, hypertensive conditions, inflammation, and environmental stress—can perturb this communication network and alter the intrauterine milieu. These changes induce persistent modifications in cardiomyocyte growth, endothelial function, and key regulatory pathways, thereby contributing to long-term cardiovascular risk. Emerging studies highlight that cardiovascular programming is governed by interconnected mechanisms involving epigenetic regulation, mitochondrial function, immune signaling, and intercellular communication. This review synthesizes current evidence on how maternal–fetal crosstalk shapes cardiovascular development beyond genetic determinants and provides an integrated framework linking early-life exposures to lifelong cardiovascular health. Full article